Reflections on the United Nations Draft Global Action Plan on Wasting

Today, an estimated 7.3% (50 million) of all children under five suffer from wasting at any given time and less than 1 in five of them are receiving treatment. In an effort to realize the Sustainable Development Goal (SDG) target of reducing the proportion of children suffering from wasting to <3% by 2030, five UN agencies[1] are developing an updated plan to more effectively prevent and treat child wasting. On March 9, 2020, these agencies released a Global Action Plan (GAP) on Child Wasting. Here, Dr. Steve Collins provides his initial reflections on the GAP. The UN agencies are expected to release a more action-oriented ‘Roadmap for Action’ in late 2020.

Key Points:

  • We have failed to address wasting at a global scale and the coverage of interventions remains extremely low.
  • The GAP attempts to address this failure by moving away from a central focus on treating wasting, to a larger emphasis on prevention.
  • Though he agrees that measures to address wasting should be more holistic and include both prevention and treatment, Dr. Collins argues that the failure to address wasting doesn’t mean that our strategy so far is wrong, just that our system failed to adequately implement it:
    • Global nutrition stakeholders have consistently under-prioritized wasting.
    • The way we deliver treatment to wasted children is not fit for purpose and has evolved little in decades.
  • The GAP is unfocused and provides no vision of how the wide variety of different actors and sectors, in particular the private sector, can be included and harnessed in practical action. Without a clear vision of how this can happen, he fears that little will change and the GAP will be little more than “business as normal”.
  • By ignoring the massive implementation failures at the heart of the system and instead focusing on strategy, the draft GAP fails to grasp a critical opportunity for reform.

Key recommendations for the Roadmap for Action:

  1. Narrow the geographic scope: preventative interventions should be tightly targeted to communities and individuals at the highest risk of wasting, rather than spread homogeneously across the developing world, as this plan appears to suggest.
  2. Implement targeted reform: Instead of fundamentally changing the strategy and massively broadening the range of interventions, focus on fixing what is manifestly wrong with the way we intervene, the coalitions of stakeholders with whom we engage, and the products we use.
  3. Focus on fundamental research: Direct limited research dollars to addressing the most foundational issues first: expanding coverage, increasing impact and improving cost-effectiveness.
  • The research agenda must acknowledge that extremely low coverage is the main factor limiting impact and answer the question: “How do we deliver support to the greatest numbers of children in the most cost-effective manner possible?”
  1. Fully engage both the public and private sector:
  • Private sector: leverage the private sector’s scale, capability and capacity along the entire chain of service delivery, up to and including last-mile delivery to those suffering from wasting.
  • Public sector: focus on ensuring that the services delivered meet the needs of those affected by wasting by improving targeting, transferring entitlements to ensure equitable coverage, and imposing ethical standards to prevent exploitation.

Key Quotes:

  • “The fact that our interventions have failed to attain an acceptable level of coverage is not, per se, evidence of a flawed strategy. It is merely an observation that we have failed. In my opinion, our collective failure to address wasting at scale is not primarily a strategic issue, but rather a failure to execute the existing strategy effectively, and it is a severe indictment of the system charged with doing this.”
  • “We still engage too little (if at all) with affected communities to ensure that interventions are understandable, acceptable and appropriate for them. The market for nutritional products targeting wasting remains non-transparent and dysfunctional, dominated by a single supplier and single customer that is also the de facto market regulator.”
  • “Is ‘focusing’ resources on several billion people who require clean water, better sanitation, universal healthcare, improved food systems and more appropriate nutritional behaviours a cost-effective way to help more than 50 million children affected by wasting each year? I do not think it is and I believe that, by casting the net so widely while ignoring key structural issues that undermine implementation, the plan inevitably turns into an unrealistic wish list.”

[1] The five agencies are United Nations Children’s Fund (UNICEF), World Food Programme (WFP), the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and the United Nations High Commission for Refugees (UNHCR)